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r-� �C� _c7 C — � <br /> CHART N0./5 - T •5 � <br /> everett i <br /> � /'�o,S'Tvr'� , <br /> � 'z6' ? � ? <br /> City of Everett ,� ; <br /> Engineering & Community Services /I�— - _ • i <br /> 1 <br /> Sewer Application and Permit � <br /> l <br /> � <br /> N0. � � _�• � J DATE �r ( (�__ � � �', b � : <br /> I <br /> i <br /> Service Address � �-�4- �1�`�-��- � �-- Utili;y Account No. j <br /> Billing Address � �-� 4' ��-� '�� �-- _ Permit Fee_ �Gl�-�E: i <br /> � <br /> I <br /> City,State, Zip = ��F`-�lT 1 c�Z.C� 1 Connection Charge�s) <br /> i <br /> Owner (Mortgagor) Total Fee NC e-.�� �� <br /> I <br /> Billing Name i <br /> Connection By � � �'� �� �-v�-�LL-1-Y <br /> Address Signed L--�-�` t�.:...�t7 C..=.=.�'=.F� Y� � <br /> Customer <br /> Phone _ � <br /> DESCRIPTION: Sewer District j <br /> Lot Block � <br /> Plat Monthly Sewer Service � <br /> Unplatted Description _Monthly Sewer Constr. <br /> Type Permit: Trunk � <br /> �-�Y'�>i � t <br /> Lateral � <br /> Remarks: .j�% �... ,6, �yS C'��,,�� 1 <br /> Abutting �ot Line � <br /> N, S, E, W ft. � <br /> %��r�c .��� �/ ' .��,,,. j <br /> 1 <br /> Approved By `— ' k•� �-�Nt t��� , <br /> City Engineer <br /> Issued By �- C c_�c_L.,���>.pV�1� � <br /> i <br /> 1 <br /> Inspection By ����Z'v� � <br /> Date Inspected (/!l y7� � <br /> J I <br /> SEE SKETCH ATTACHED N0. � <br /> �" •_' ,. ,.- s , ,. _ ' <br />